Today I helped someone eat her lunch.  She is a very elegant lady with excellent caregivers and very deep into Alzheimer Disease.  She did enjoy her Swedish meatballs and red cabbage but the okra was too rough for her and she spent time carefully taking out the little hard bits.  So sensitive to every bite and yet totally oblivious to the extra big spoon we give her to help her on the long trip to her mouth.

   I thought of the many people I have helped with meals over the last twenty years.  The act of helping someone eat is a holy communion.  From babies nursing to  the dying with just a few slivers of ice at the end, each bit of nutrition is intense.  However it can become drudgery too with high chairs filled with food crumbs to the mess we made today on the lunch table with the red cabbage and crusts of bread. 

    At the nursing home where I worked we had two ladies who refused to eat for long periods of time.  They just went on a hunger strikes because they wanted to die and end the incarceration.   If only they had enjoyed the time they had instead of wanting to escape.  We had another lady who loved life and enjoyed every bite.  She died with horrible intestinal complications.  Life is not fair.

    One of the wives of our Alzheimer patient so long ago wanted to feed him and he loved every bite.  However he got very heavy with all the attention and we had a hard time getting him up and dressed.  When there are several people who need help eating in a facility the staff gets to as many as they can and it evens out somehow.  Families can do too much to make their loved ones happy.  

    We had one Alzheimer patient who was in the final stages of this horrible disease.  At the end some patients get frozen into a fetal position and it is not possible to eat.  However this poor woman was arched back with her mouth open and we were required by law and her family to continue to feed her.  We put her in the dining room in her rolling bed and it was difficult for the other residents to be near her.  But we fed her with great compassion and care and she lived many years in this position.  

  In a home caregiving position I was in charge of a little lady who had a terrible time eating.  I ended up putting things in the blender and she enjoyed her hot bowl of "soup" every day.  I think soft food is a good way to eat as it is easy on your digestive system.  Unfortunately she had a stroke and was paralyzed in her mouth and throat area.  I tried to feed her with a little spoon but I couldn't even get her antipsychotic pill down her throat.  I could see the fear in her eyes.  I do not believe in a feeding tube for someone like this who was 99 years old and after seven days of no food or water she finally passed away.  It was not easy.

   The patients who cannot see to eat need lots of help.  Macular degeneration causes a grey fog to be in front of your eyes and so you can only see out of the side.  This causes trouble when trying to see where the fork is.  Utensils have to be placed in the same place and then the dementia makes everything even more confusing.  It is always amazing to me how it does work.  Eating is one of the last pleasures and people adapt so that they can experience it until the end.

    Chewing and swallowing become difficult with Alzheimer Disease.  I knew one patient who had a sip of milk in her mouth for two hours.  She just couldn't swallow it.  Another lady asked for an "ocean".  It took me a little bit to realize that she wanted more milk and her brain came thru with liquid and pulled the closest word to that as "ocean".  Adapt.

     My favorite fellow would not eat at all.  It is always a challenge to break thru that barrior and I handed him a bananna.  "Well," he said " I could peel it for you but first you would have to give me your name and address."  

     I asked another lady if she would like some lunch and she said, "No thank you, I ate yesterday."   Oh my, the mind and body connection is so fragile.  Enjoy every bite and every sip of water.  Don't take anything for granted.